4Any of the aboveAny of the above plus diarrheaAny of the above,hoarseness, "barky" cough, difficulty swallowing, dyspnea, wheezing, cyanosisAny of the above,dysrhythmia and/or mild hypotension"Light headedness," feeling of "pending doom"

5Any of the aboveAny of the above, loss of bowel controlAny of the above,respiratory arrestSevere bradycardia and/or hypotension or cardiac arrestLoss of consciousness

All symptoms are not mandatory. The severity score should be based on the organ system most affected, eg, if grade 3 respiratory symptoms are present but only grade 1 GI symptoms, then the anaphylaxis severity score would be "grade 3." Boldface symptoms are absolute indications for the use of epinephrine; use of epinephrine with other symptoms will depend on patient’s history.